U.S. patent number 6,929,632 [Application Number 10/185,397] was granted by the patent office on 2005-08-16 for ultrasonic devices and methods for ablating and removing obstructive matter from anatomical passageways and blood vessels.
This patent grant is currently assigned to Advanced Cardiovascular Systems, Inc.. Invention is credited to Timothy C. Mills, Henry Nita.
United States Patent |
6,929,632 |
Nita , et al. |
August 16, 2005 |
**Please see images for:
( Certificate of Correction ) ** |
Ultrasonic devices and methods for ablating and removing
obstructive matter from anatomical passageways and blood
vessels
Abstract
Disclosed are methods and devices for removing obstructive
matter from anatomical passageways, including the removal of
obstructive matter from the cerebral vasculature, prostatic
obstructions from the urinary tract and/or obstructive matter from
the fallopian tubes.
Inventors: |
Nita; Henry (Mission Vieyo,
CA), Mills; Timothy C. (Corona Del Mar, CA) |
Assignee: |
Advanced Cardiovascular Systems,
Inc. (Santa Clara, CA)
|
Family
ID: |
26917337 |
Appl.
No.: |
10/185,397 |
Filed: |
June 27, 2002 |
Related U.S. Patent Documents
|
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
388794 |
Sep 2, 1999 |
6454757 |
|
|
|
815673 |
Mar 12, 1997 |
5957882 |
|
|
|
222999 |
Apr 5, 1994 |
|
|
|
|
640190 |
Jan 11, 1991 |
5304115 |
|
|
|
Current U.S.
Class: |
604/508; 604/22;
606/169; 606/41 |
Current CPC
Class: |
A61B
17/22012 (20130101); A61F 2210/0042 (20130101); A61B
2017/320073 (20170801); A61B 2017/22039 (20130101); A61M
2025/0183 (20130101); A61F 2002/30092 (20130101); A61B
2017/00101 (20130101); A61B 2018/00011 (20130101); A61B
2017/00849 (20130101); A61B 2017/22041 (20130101) |
Current International
Class: |
A61B
17/22 (20060101); A61B 17/00 (20060101); A61B
17/32 (20060101); A61B 18/00 (20060101); A61F
2/00 (20060101); A61M 031/00 () |
Field of
Search: |
;604/508,21,22,517,500,515,73,113,523,2
;606/49,41,28,31,159,193,169-171 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
|
|
|
|
|
|
|
2349120 |
|
Apr 1975 |
|
DE |
|
2438648 |
|
Feb 1976 |
|
DE |
|
2453058 |
|
May 1976 |
|
DE |
|
2453126 |
|
May 1976 |
|
DE |
|
2541919 |
|
Mar 1977 |
|
DE |
|
2703486 |
|
Dec 1977 |
|
DE |
|
8119209 |
|
Oct 1981 |
|
DE |
|
3707921 |
|
Mar 1986 |
|
DE |
|
3726210 |
|
Aug 1987 |
|
DE |
|
3707567 |
|
Sep 1987 |
|
DE |
|
3707921 |
|
Sep 1987 |
|
DE |
|
3826414 |
|
Feb 1989 |
|
DE |
|
3812836 |
|
Apr 1990 |
|
DE |
|
4114826 |
|
May 1991 |
|
DE |
|
189329 |
|
Jul 1986 |
|
EP |
|
293472 |
|
Nov 1986 |
|
EP |
|
0 208 175 |
|
Jan 1987 |
|
EP |
|
208175 |
|
Jan 1987 |
|
EP |
|
0209468 |
|
Jan 1987 |
|
EP |
|
234951 |
|
Feb 1987 |
|
EP |
|
0424231 |
|
Apr 1989 |
|
EP |
|
0 316 796 |
|
May 1989 |
|
EP |
|
347098 |
|
Jun 1989 |
|
EP |
|
315290 |
|
Oct 1989 |
|
EP |
|
443256 |
|
Dec 1990 |
|
EP |
|
472368 |
|
Feb 1992 |
|
EP |
|
2424733 |
|
Nov 1980 |
|
FR |
|
2 641 693 |
|
Jul 1990 |
|
FR |
|
2641693 |
|
Jul 1990 |
|
FR |
|
2 643 272 |
|
Aug 1990 |
|
FR |
|
2643272 |
|
Aug 1990 |
|
FR |
|
1520448 |
|
Aug 1978 |
|
GB |
|
1531659 |
|
Nov 1978 |
|
GB |
|
2208138 |
|
Mar 1989 |
|
GB |
|
2212267 |
|
Jul 1989 |
|
GB |
|
WO 87/01276 |
|
Mar 1987 |
|
WO |
|
WO 87/05793 |
|
Oct 1987 |
|
WO |
|
WO 89/05123 |
|
Jun 1989 |
|
WO |
|
WO 89/06515 |
|
Jul 1989 |
|
WO |
|
WO 89/07419 |
|
Aug 1989 |
|
WO |
|
WO 90/01300 |
|
Feb 1990 |
|
WO |
|
WO 90/07303 |
|
Jul 1990 |
|
WO |
|
WO 91/02489 |
|
Mar 1991 |
|
WO |
|
WO 91/14401 |
|
Oct 1991 |
|
WO |
|
WO 92/10140 |
|
Jun 1992 |
|
WO |
|
WO 92/11815 |
|
Jul 1992 |
|
WO |
|
WO 92/15253 |
|
Sep 1992 |
|
WO |
|
Other References
Circulation, vol. 81, No. 2, Feb. 1990, "Application of a New
Phased-Array Ultrasound Imaging Catheter in the Assessment of
Vascular Dimensions," pp. 660-666. .
"Ultrasonic Energy Causes Doe-Dependent, Endothelium-Independent
Arterial Relaxation "-T. Fischell, et al. Abstracts of the 63rd
Scientific Sessions, pp. 111-219..
|
Primary Examiner: Rodriguez; Cris L.
Attorney, Agent or Firm: Fulwider Patton Lee & Utecht,
LLP
Parent Case Text
RELATED APPLICATION AND INCORPORATION BY REFERENCE
This patent application is a divisional of U.S. patent application
Ser. No. 09/388,794, filed Sep. 2, 1999, which is now U.S. Pat. No.
6,454,757, which is a divisional of U.S. patent application Ser.
No. 08/815,673 filed Mar. 12, 1997, which is now U.S. Pat. No.
5,957,882, which is a continuation of U.S. patent application Ser.
No. 08/222,999 filed Apr. 5, 1994, now abandoned, and is a
continuation-in-part of U.S. patent application Ser. No. 07/640,190
filed Jan. 11, 1991, which is now U.S. Pat. No. 5,304,115, and the
entirety of each is expressly incorporated herein by reference.
Also, applicant expressly incorporates herein by reference the
entirety of U.S. Pat. No. 5,267,954 entitled ULTRASOUND CATHETER
FOR REMOVING OBSTRUCTIONS FROM TUBULAR ANATOMICAL STRUCTURES SUCH
AS BLOOD VESSELS, issued Dec. 7, 1993.
Claims
What is claimed is:
1. A method of ultrasonically treating an obstruction of a blood
vessel, said method comprising the steps of: a) providing an
ultrasound catheter having a proximal end and a distal end, said
catheter comprising: i) an elongate flexible catheter having a
proximal end, a distal end and a longitudinal axis extending
longitudinally therethrough; ii) at least one ultrasound
transmission member extending longitudinally through said catheter
body and coupleable to an ultrasound source, said ultrasound
transmission member having a distal end which is substantially
coterminous with the distal end of said catheter body; iii) at
least one fluid infusion lumen extending longitudinally through
said catheter body and opening through at least one fluid outflow
aperture formed at the distal end of said catheter body; iv) at
least one aspiration lumen extending longitudinally through said
catheter body and opening through at least one aspiration port
formed in the distal most centimeter of said catheter body; b)
inserting said catheter device, distal end first, into the
vasculature and advancing said catheter to a point where the distal
end of said catheter is adjacent the obstruction to be treated; c)
coupling said ultrasound transmission member to an ultrasound
source and utilizing said ultrasound source to pass ultrasound
through said ultrasound transmission member to the distal end of
said catheter; d) infusing a liquid infusate through said infusion
lumen in contact with said ultrasound transmission member and out
of said distal outflow aperture, thereby removing excess heat from
said ultrasound transmission member; e) applying suction to said
aspiration lumen to draw matter into said distal aspiration port
and through said aspiration lumen of said catheter.
2. The method of claim 1 utilized to treat a cerebral vascular
obstruction, wherein step b) of said method further comprises:
inserting said catheter, distal end first, into the vasculature and
advancing said catheter to a point where the distal end of said
catheter is positioned in an intracranial or extracranial cerebral
blood vessel, adjacent the obstruction to be treated.
3. The method of claim 2 wherein the obstruction to be treated is
in a carotid artery and wherein the distal head of said catheter is
positioned within said carotid artery adjacent the obstruction to
be treated.
4. The method of claim 2 wherein the obstruction to be treated is
in a vertebral artery and wherein step b) further comprises
positioning the distal end of said catheter within said vertebral
artery adjacent the obstruction to be treated.
5. The method of claim 2 wherein the obstruction to be treated is
in a basilar artery and wherein step b) further comprises
positioning the distal end of said catheter within said basilar
artery adjacent the obstruction to be treated.
6. The method of claim 2 wherein the obstruction to be treated is
in a anterior cerebral artery and wherein step b) further comprises
positioning the distal end of said catheter within said anterior
cerebral artery adjacent the obstruction to be treated.
7. The method of claim 2 wherein the obstruction to be treated is
in a middle cerebral artery and wherein step b) further comprises
positioning the distal end of said catheter within said middle
cerebral artery adjacent the obstruction to be treated.
8. The method of claim 2 wherein the obstruction to be treated is
in a posterior cerebral artery and wherein step b) further
comprises positioning the distal end of said catheter within said
posterior cerebral artery adjacent the obstruction to be
treated.
9. The method of claim 2 wherein said method further comprises the
step of: maintaining the rate of infusion through said infusion
lumen and maintaining the rate of aspiration through said
aspiration lumen such that said rates of infusion and aspiration
are substantially equivalent.
10. The method of claim 1 wherein step c) further comprises:
utilizing said ultrasound source to pass ultrasound within the
frequency range of 20 kHz to 1 MHz through said ultrasound
transmission member to the distal end of said catheter to thereby
cause ultrasound induced smooth muscle relaxation and resultant
dilation of the anatomical passageway.
Description
FIELD OF THE INVENTION
The present invention pertains generally to medical equipment and,
more particularly, to ultrasonic devices and methods for removing
obstructive matter from anatomical passageways, including the
removal of obstructive matter from the cerebral vasculature,
prostate tissue from the urinary tract and/or obstructive matter
from the fallopian tubes.
BACKGROUND OF THE INVENTION
The prior art has included various ultrasonically vibrated surgical
and ablative instruments for treating obstructive disorders of
blood vessels and other anatomical passageways or cavities.
The prior art devices which, purportedly utilize ultrasonic energy,
alone or in conjunction with other treatment modalities, to treat
obstructions within blood vessels or other anatomical structures of
the body include those described in U.S. Pat. No. 3,433,226 (Boyd),
U.S. Pat. No. 3,823,717 (Pohlman, et al.), U.S. Pat. No. 4,808,153
(Parisi), U.S. Pat. No. 4,936,281 (Stasz), U.S. Pat. No. 3,565,062
(Kuris), U.S. Pat. No. 4,924,863 (Sterzer), U.S. Pat. No. 4,870,953
(Don Michael, et al.), U.S. Pat. No. 4,920,954 (Alliger, et al.),
and U.S. Pat. No. 5,100,423 (Fearnot), U.S. Pat. No. 4,136,700
(Broadwin), U.S. Pat. No. 4,192,294 (Vasilevsky), U.S. Pat. No.
4,750,448 (Wuchinich), U.S. Pat. No. 4,750,902 (Wuchinich), U.S.
Pat. No. 4,765,332 (Fischell), U.S. Pat. No. 4,808,153 (Parisi),
U.S. Pat. No. 4,832,023 (Murphy-Chutorian), U.S. Pat. No. 4,867,141
(Nakada), U.S. Pat. No. 4,870,953 (Don Michael), U.S. Pat. No.
4,877,033 (Seitz), U.S. Pat. No. 4,886,061 (Fischell), U.S. Pat.
No. 4,922,902 (Wuchinich), U.S. Pat. No. 4,936,281 (Stasz), U.S.
Pat. No. 4,974,581 (Wiksell), U.S. Pat. No. 4,989,588 (Kubota),
U.S. Pat. No. 5,058,570 (Idemoto), U.S. Pat. No. 5,069,664 (Guess),
U.S. Pat. No. 5,149,319 (Unger), U.S. Pat. No. 5,151,084 (Khek),
U.S. Pat. No. 5,154,723 (Kubota), U.S. Pat. No. 5,156,143
(Bocquett), U.S. Pat. No. 5,163,421 (Bernstein), U.S. Pat. No.
5,163,433 (Kagawa), as well as foreign publications nos. WO87-05739
(Cooper), WO89-06515 (Bernstein, et al.), WO90-0130 (Sonic Needle
Corp.), EP316789 (Don Michael, et al.), DE3,821,836 (Schubert),
DE2,438,648 (Pohlman), GB 1,531,659 (Gekhman, et al.), EP 342448
(Bakelite), EP 293472 (Bakelite), and EP 209468 (Sarl).
Although the prior art has included numerous devices for ultrasonic
treatment of intracorporeal obstructions, there remains a need in
the art for the development of new and improved ultrasonic devices
having improved or differing capabilities for specific blood
vessels or regions of the body, such as the intracranial and
extracranial vessels of the cerebral vasculature and/or the tubes
and ducts of the genitourinary tracts of the male and female.
SUMMARY OF THE INVENTION
The present invention provides methods for ultrasonically treating
obstructions of anatomical passageways of the mammalian body with
concomitant infusion of a fluid (e.g., saline solution) in a manner
which will dilate or fluidically expand the surrounding anatomical
structure so as to facilitate passage of a catheter through the
obstructed region of the anatomical structure. Methodologies in
accordance with this embodiment of the invention are particularly
useful in treating intravascular obstructions as well as
obstructions of the male or female urogenital tract, including, but
not limited to obstructions of the fallopian tubes and prostatic
obstructions of the male urethra.
Further in accordance with the invention, there are provided
methods for ultrasonically treating obstructions within anatomical
passageways of the mammalian body while concomitantly aspirating
and removing matter from the anatomical passageway so as to prevent
escape of solid particles or other matter created or released by
the ultrasonic treatment process In accordance with this embodiment
of the invention, there are provided methodologies which are
particularly applicable in the ultrasonic treatment of obstructions
within intracranial and extracranial cerebral blood vessels which
supply blood to the mammalian brain.
Further in accordance with the invention, there is provided a first
embodiment of an ultrasound treatment system incorporating an
ultrasound delivery catheter having one or more fluid infusion
lumens for infusing fluid through the catheter, to effect fluidic
dilation of the anatomical structure wherein the obstruction is
located.
Still further in accordance with the invention, there is provided a
second embodiment of an ultrasound treatment system incorporating
an ultrasound delivery catheter having at least one aspiration
lumen extending longitudinally through the catheter to aspirate and
remove particles or other debris from the anatomical structure
wherein the obstruction is located.
Further objects and advantages of the invention will become
apparent to those skilled in the art upon reading and understanding
the following detailed description and the accompanying
drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of a first embodiment of an ultrasonic
system of the present invention for removing obstructions from
genitourinary pathways or other anatomical structures of the
body.
FIG. 2 is an enlarged perspective view of a first embodiment of a
distal catheter tip which may be incorporated in the system of FIG.
1.
FIG. 3 is a longitudinal sectional view through line 3--3 of FIG.
2.
FIG. 4 is a cross-sectional view through line 4--4 of FIG. 3.
FIG. 5 is an enlarged perspective view of a second embodiment of a
catheter tip which may be incorporated into the ultrasound system
of FIG. 1.
FIG. 6 is a longitudinal sectional view through line 6--6 of FIG.
5.
FIG. 7 is a cross-sectional view through line 7--7 of FIG. 6.
FIG. 8 is a perspective view of a second embodiment of an
ultrasound treatment system of the present invention.
FIG. 9 is an enlarged perspective view of a distal catheter tip
which may be incorporated into the ultrasound system of FIG. 8.
FIG. 10 is a longitudinal sectional view through line 10--10 of
FIG. 9.
FIG. 11 is a cross-sectional view through line 11--11 of FIG.
10.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
The following detailed description and the accompanying are
provided for purposes of describing and illustrating presently
preferred embodiments of the invention and are not intended to
cover every possible embodiment or configuration of the invention,
nor are they intended to limit the scope of the accompanying claims
in any way.
With references to the drawings, FIGS. 1-7 are directed to a first
embodiment of the invention preferably useable to dilate and treat
obstructive disorders of various anatomical passageways, including
the urethra and/or fallopian tubes. FIGS. 8-11 are directed to a
second embodiment of the invention preferably useable to effect a)
ultrasonic ablation of obstructive matter and b) aspiration of the
reduced or morseled matter from the treatment site, such as a
cerebral blood vessel or other passageway of the body wherein
prompt aspiration or removal of any solid matter is desired.
i. Elements and Components of the First Embodiment
A first embodiment of an ultrasound treatment system 10 of the
present invention, shown in FIG. 1, comprises an electrical signal
generator 12 (e.g., Model UAG-1110, Baxter Healthcare Corporation,
Cardiovascular Group, Interventional Cardiology Division, Irvine,
Calif.) connected by way of cable 13 to an ultrasound transducer 14
(e.g., Model UAT-1000, Baxter Healthcare Corporation, Irvine,
Calif.) operable to convert the electrical signal from the signal
generator 12, into ultrasonic vibration. An elongate ultrasound
catheter 16 is coupled to the ultrasound transducer 14 to transmit
ultrasonic vibration from the transducer 14 to a desired treatment
location adjacent the distal end of the catheter 16.
The catheter 16 component of the first embodiment of the ultrasound
treatment system 10 may comprise an elongate flexible catheter body
18 formed of pliable material and an elongate ultrasound
transmission wire or member 20 which extends longitudinally through
the catheter body 18. The ultrasound transmission wire or member 20
extends proximally through a proximal connector assembly 22 whereby
the proximal end of the ultrasound transmission member 20 may be
coupled or attached to the ultrasound generating horn of the
ultrasound transducer 14. The distal end of the ultrasound
transmission member 20 is coupled or attached to a distal head
member 30 at the distal end of the catheter 16.
The structure and configuration of the proximal connector assembly
22 of the first embodiment may be the same as that described and
shown in FIG. 10 of U.S. Pat. No. 5,267,954 (Nita), the entirety of
such patent being hereby expressly incorporated herein by
reference.
A fluid infusion sidearm 24 extends from proximal connector
assembly 22 and is fluidly communicative with a hollow bore
extending through at least a distal portion of the proximal
connector assembly 22 and into an elongate hollow infusion fluid
lumen 26 extending through the catheter body 18. A source 28 of
pressurized or pumped liquid (e.g., 0.9% NaCl solution) is
connected to the fluid infusion sidearm 24 to permit infusion of
fluid through the bore of the proximal connector assembly 22 and
through the elongate lumen 26 of the catheter body 18. A distal
head member 30, is mounted on the distal end of the catheter body
18. Such distal head member may be of any suitable configuration,
including the blunt horizontal faced configuration 30a shown in
FIGS. 2-3 and the bullet-like configuration 30b shown in FIGS. 5-6.
In any case, the distal head member 30 will be provided with one or
more fluid outflow apertures 34a/34b which are fluidly
communicative with the fluid lumen 26 of the catheter body 18 to
permit irrigation fluid to flow out of the distal head 30 of the
catheter 16.
In the blunt distal head embodiment 30a shown in FIGS. 2-3, the
configuration of the distal head member 30 is such that there is
provided a frontal portion 36 having an outer diameter
substantially equal to the outer diameter of the catheter body 18,
and a rear portion 38 having an outer diameter substantially equal
to the inner diameter at the distal head of the catheter lumen 26
by such configuration, the rear portion 38 of the distal head
member 30a may be inserted into the distal end opening of the lumen
26 of catheter body 18 and secured thereto by frictional
engagement, mechanical engagement, adhesive, heat sealing or other
suitable means. The outer surface of the frontal portion 36 of the
distal head member 30a is thus rendered substantially continuous
and in smooth transition with the outer surface of the adjacent
catheter body 18. The distal head member 30a has a central fluid
passageway 32a formed therein, separate and apart from the
guidewire passageway 40a which extends longitudinally through the
lower portion of the distal head member 30a. Such central fluid
passageway 32a opens into ancillary passageways 42a, said ancillary
passageways 42a terminating laterally in the multiple fluid outflow
apertures 34a formed in the sides of the distal head member 30a. By
such arrangement, fluid infused through the lumen 26 of the
catheter body 18 will enter the central fluid passageway 32a, of
the distal head member, 30a and will subsequently pass outwardly
through the lateral fluid passageways 42a and out of the fluid
outflow apertures 34a. This may be accomplished while a guidewire
(phantom lines) remains inserted into guidewire passageway 40a,
thereby substantially blocking fluid outflow through guidewire
passageway 40a.
The rate of fluid outflow through outflow apertures 34a may be
controlled to effect any desired degree of irrigation and/or
fluidic dilation of a surrounding anatomical structure (e.g.,
fallopian tube, ureter, duct, blood vessel, etc. . . . ).
The alternative distal head configuration 30b shown in FIGS. 5-7
provides a distal head member 30b having a frontal portion 36b and
a rear portion 38b. Said frontal portion 36b having an outer
diameter substantially equal to the outer diameter of the adjacent
catheter body 18. Said rear portion 38b has an outer diameter
substantially equal to the inner diameter of the distal end of the
catheter lumen. By such configuration, the rear portion 38b of the
distal head member 30b may be inserted into the distal end of the
catheter lumen and secured thereto by frictional engagement,
mechanical engagement, heat sealing, chemical adhesive, or any
other suitable means. When so constructed, the lateral outer
surface of the distal head member 30b is continuous, and
substantially flush with the adjacent outer surface of the catheter
body 18, as shown. The alternative distal head member 30b shown in
FIGS. 5-7 also differs from the distal head member 30a shown in
FIGS. 2-4 in that the guidewire passageway 40b serves as the
central fluid passageway of the distal head 30b, as well as serving
as the guidewire passageway through which a guidewire may pass
longitudinally through the distal head member 30b (see guidewire
shown in phantom lines).
Fluid outflow passageways 42b pass fluid laterally outward from the
central guidewire lumen fluid passageway 40b and lead to multiple
fluid outflow apertures 34b. Thus, when the guidewire (phantom
lines) has been removed or retracted so as not to block fluid entry
into the guidewire passage lumen/central fluid passageway 40b,
irrigation/dilation/coolant fluid may be infused through the lumen
of the catheter body 18, through the guidewire passageway/central
fluid passageway 40b and subsequently outward through the lateral
fluid passageways 42b and lateral fluid outflow apertures 34b, as
well as through the frontal guidewire passageway opening 40b. The
flow rate and volume of fluid so infused may be controlled to
effect any desired degree of irrigation or dilation of a
surrounding anatomical structure (e.g., fallopian tube, ureter,
blood vessel or other anatomical passageway).
ii. Preferred Modes of Operation of the First Embodiment
The ultrasound system 10 of the first embodiment shown in FIGS. 1-7
may be utilized for ultrasonic-treatment of various obstructive
disorders of the mammalian body wherein it is desirable to effect
concomitant fluid irrigation or fluid dilation of the anatomical
structure whereat the distal end of the catheter 18 is
positioned.
Examples of procedures wherein the ultrasound system 10 of the
first embodiment may be employed include the ultrasonic ablation of
atherosclerotic plaque, thrombus or other obstructive matter within
the lumen(s) of mammalian blood vessel(s). Also, as described more
fully in the examples set forth herebelow, the ultrasound system 10
of the first embodiment may be utilized to effect dilation and/or
removal of obstructive matter (e.g., scar tissue, tumors,
congenitally aberrant tissue, etc. . . . ) which obstruct tubular
passageways of the body including the ducts and passageway of the
urogenital tract (e.g., urethra, ureter, fallopian tubes).
EXAMPLE 1
In a first example, an ultrasound system 10 of the first embodiment
of the present invention may be utilized to treat obstructions of
the fallopian tubes of a female human being.
Fallopian tube obstructions are known to occur due to the formation
of scar tissue within the lumens of the fallopian tubes following
the occurrence of fallopian tube infections, such as chlamydia
infections.
In treating such blockage of the fallopian tubes, a standard
guidewire having an outer diameter of approximately 0.14..div.0.25
inch is inserted transvaginally and advanced, with radiographic
and/or endoscopic guidance, into the obstructed fallopian tube to a
point where the distal end of the guidewire 50 is situated adjacent
the offending fallopian tube obstruction. After the guidewire has
been positioned, the proximal end of the guidewire 50 is inserted
into the distal guidewire passageway 40a/40b of the catheter 18 and
the catheter 18 is advanced over the guidewire, using standard
catheter advancement technique, to a point where the distal head 30
of the catheter 18 has been advanced to a position adjacent the
obstruction to be treated. During such advancement of the catheter,
the proximal end of the guidewire 50 will emerge out of the
guidewire sidearm 52 of the proximal connector assembly 22 so as to
render the proximal portion of the guidewire freely accessible to
the operator for subsequent manipulation, extraction or exchange of
the guidewire 50, if desired.
The pressurized fluid source or pump 28 is then utilized to pass a
flow of irrigation/dilation fluid, such as 0.9% NaCl solution or
other physiologically compatible liquid, through line 56 and into
sidearm 24 of proximal end connector assembly 22. The fluid so
infused will then pass, in the distal direction, through the
internal bore of the proximal connector assembly 22, through the
lumen 26 of catheter 18 and out of the fluid outflow apertures
34a/34b of the distal head 30 of the catheter device 16.
The flow rate of irrigation/dilation fluid out of outflow apertures
34a/34b may be adjusted and controlled so as to provide a
controlled degree of a) fluid-induced dilation of the fallopian
tube lumen immediately adjacent the obstruction to be treated
and/or b) impingement of fluid against the obstructing scar tissue
or other matter.
Thereafter, the signal generator 12 may be energized by depression
of on/off foot pedal 11, thereby sending an electrical signal
through line 13 to ultrasound transducer 14. Such electrical signal
is converted to ultrasonic vibration by ultrasound transducer 14
and the ultrasonic vibration is passed, via proximal connector
assembly 22, into the ultrasound transmission wire or member 20,
thereby causing ultrasonic vibration of the distal head 30 of the
catheter 16.
With continued infusion of the irrigation/dilation fluid, the
catheter 16 may be advanced, or otherwise moved back and forth,
such that the ultrasonic vibration of the distal head 30 of the
catheter 16 will effect morcellation or reduction of the
obstructive matter. Such morcellation or reduction of the
obstructive matter by the ultrasonic vibration of the distal head
30 may be effected by direct contact of the vibrating distal head
30 against the obstructive matter and/or by cavitation effect
created as a result of the ultrasonically vibrating distal head 30
in the fluid environment created by the controlled infusion of the
infusion/dilation fluid adjacent the obstructive lesion to be
treated.
In some cases, it may be desirable to initially employ a first
catheter 16 having a distal head 30 designed for initial dilation
of the surrounding fallopian tube lumen and impingement of the
irrigation fluid against the offending lesion, and to subsequently
utilize one or more additional embodiments of the catheter 16
having different designs of the distal head 30 so as to effect
differing degrees of fluid impingement against the offending lesion
and/or fluidic dilation of the surrounding luminal wall of the
fallopian tube, during differing stages of the procedure. For
example, in some procedures it may be desirable to utilize three
(3) separate catheter devices 16, as follows:
CATHETER 1 Small size Distal head having one or (OD = .5-1.2 mm)
more fluid outflow apertures in frontal surface of tip to direct
irrigation/dilation fluid into direct impingement with obstructive
matter. CATHETER 2 Medium size Distal head having fluid (OD =
1.2-2.0 mm) outflow apertures in frontal surface of tip and around
the lateral sides of tip so as to simultaneously direct
irrigation/dilation fluid in a) a forward direction so as to
impinge against the obstructive matter and b) in lateral directions
so as to exert external dilatory pressure against the surrounding
tube wall. CATHETER 3 Large size Distal head having no fluid (OD =
2.0-3.5 mm) outflow apertures in front surface of tip and multiple
fluid outflow apertures around lateral sides of tip to exert
lateral dilatory pressure against the surrounding tube only.
In addition to effecting ultrasonic ablation or breakdown of the
obstructive matter, the ultrasonic vibration of the distal head 30
of the catheter 16 may also cause relaxation of smooth muscle and
resultant dilation of the fallopian tube, thereby permitting the
catheter 16 to be advanced back and forth through the previously
obstructed region of the fallopian tube.
In this example, it is preferable that the ultrasonic vibration of
the distal catheter tip 30 be of an optimized frequency and wave
form modulation to effect the desired ablation of the obstruction
for inducing smooth muscle relaxation and resultant dilation of the
obstructed fallopian tube.
One or more inflatable dilation balloons mounted on the ultrasound
catheter device 16 or mounted on a separate balloon catheter may be
utilized in conjunction with the ultrasound catheter 16, to effect
dilation and opening of the obstructed region of the fallopian
tube.
After the procedure has been completed and the patency of the
obstructed fallopian tube restored, the catheter 16 may be
extracted and removed.
EXAMPLE 2
In a second example, the ultrasound system 10 of the first
embodiment of the present invention may be utilized to treat
obstructions of the male urethra resulting from benign prostatic
hypertrophy or other prostate enlargement.
In this example, the catheter device 16 of the first embodiment is
inserted, with or without the assistance of a pre-inserted
guidewire 50, into the male urethra. The catheter 16 is then
advanced to a point where the distal head 30 of the catheter 16 is
positioned adjacent the obstructing prostatic tissue.
A pressurized fluid source or pump 28 may be utilized to pump or
otherwise expel fluid through tube 54, through sidearm 24, through
the longitudinal bore of the proximal connector assembly 22,
through the lumen 26 of catheter 16 and out of the distal fluid
outflow apertures 34a/34b. The flow rate and quantity of the
irrigation/dilation fluid being infused may be specifically
adjusted and/or controlled so as to effect the desired degrees of
a) impingement of the fluid against the obstruction and/or b)
fluidic dilation of the surrounding anatomical structures (e.g.,
the urethra).
Concomitant with the infusion of the irrigation/dilation fluid,
signal generator 12 may be energized by depression of on/off foot
pedal 1, thereby sending an electrical signal through line 13 to
ultrasound transducer 14. Ultrasound transducer 14 will convert the
electrical signal to ultrasonic vibration and, via proximal
connector assembly 22, will pass such ultrasound vibration through
ultrasound transmission member 20 to the distal head 30 of the
catheter 16. Ultrasonic vibration from the catheter tip may thereby
result in a) relaxation and dilation of the smooth muscle of the
urethra and/or b) ultrasonic ablation or morselling of the
obstruction.
For smooth muscle relaxation the preferred ultrasound frequency is
20 kz to 1 MHz. For morselling or ablating the obstructing prostate
tissue, the preferred ultrasound frequency is 20 kz to 100 MHz.
As described above in Example 1, it may also be desirable to
utilize two or more separate catheters 16 having distal heads 30 of
differing design, with different positions and configurations of
the fluid outflow apertures 34a/34b, to facilitate optimal
performance of various phases of the procedure.
After the prostatic obstruction of the urethra has been
ultrasonically ablated and/or dilated so as to restore patency and
urinary flow through the urethra, the catheter 16 may be extracted
and removed.
The foregoing Examples 1 and 2 are intended to illustrate certain
specific intended applications of the ultrasound system 10 of the
first embodiment of the invention, and are not intended to provide
a comprehensive discussion of all possible ablative or dilative
procedures wherein the ultrasound system 10 may be employed.
iii. Elements and Components of the Second Embodiment
FIGS. 8-11 of the drawings are directed to a second embodiment of
an ultrasound system 10a of the present invention. As shown, such
second embodiment ultrasound system 10a generally comprises a
signal generator 12a, an ultrasound transducer 14a and an elongate
catheter 16a, having a proximal connector assembly 22a positioned
on the proximal end thereof for coupling the catheter 16a to the
ultrasound transducer 14a.
The proximal connector assembly 22a of the second embodiment
ultrasound system 10a may be constructed and configured
substantially the same as that described here above and in
incorporated U.S. Pat. No. 5,267,954 (Nita), however it will be
appreciated that in accordance with the showing of the second
embodiment in FIG. 8 of this patent application such ultrasound
connector assembly 22a will include an additional suction or
aspiration sidearm 60 and a separate suction or aspiration tube or
secondary lumen (not shown) within the hollow bore of the connector
assembly 22a and which is continuous with and fluidically connected
to an aspiration lumen or tube member to which extends
longitudinally through the catheter body 18a for withdrawal or
aspiration of debris.
The catheter 16a preferably comprises an elongate flexible catheter
sheath having an ultrasound transmission member or wire 20a
extending longitudinally therethrough. The proximal end of the
ultrasound transmission member or wire 20a extends proximally
through the proximal connector assembly 22a and is thereby
coupleable or connectable to the ultrasound transducer 14a. The
distal end of the ultrasound transmission member wire 20a is
coupled or connected to the distal head member 30c of the catheter
16a so as to transmit ultrasonic vibration into the distal head
member 30c.
The catheter 16a of the second embodiment shown in FIGS. 8-11 is a
"monorail" type of catheter having a guidewire passage lumen 51
extending only through a distal portion of the catheter body 18a.
In the embodiment shown, the guidewire passage lumen 51 comprises a
tube which extends from the distal guidewire passage aperture 40c
formed in the distal end of the distal head member 30c to a
sidewall guidewire passage aperture 41a formed in the sidewall of
the catheter body 18a, at a location such as that shown in FIG. 8.
By such "monorail" arrangement, the proximal end of a guidewire may
be passed into distal guidewire aperture 40c and advanced through
guidewire lumen 51 so as to subsequently exit the catheter body 18a
through sidewall aperture 41a. The proximal portion of the
guidewire 50 may reside outboard of the catheter body 18a as is
typical of "monorail" type catheters.
It will be appreciated that an over-the-wire embodiment may also be
designed incorporating a guidewire tube or lumen which extends
longitudinally through the entire catheter body 18a, with a
separate guidewire passage sidearm formed in the proximal connector
22a, in a manner similar or the same as that shown in FIG. 1 with
respect to the first embodiment described hereabove.
An aspiration tube member 70 extends longitudinally through the
internal bore 26a of the catheter body 18a and longitudinally
through a separate dedicated bore formed in the distal head member
30c as shown. The distal end of the aspiration tube member 70 is
flush with the distal or frontal face of the distal head member
30c. The proximal end of the aspiration tube member 70 is fluidly
connected or continuous with aspiration sidearm 60, thereby forming
a continuous dedicated aspiration channel through the catheter 16a.
Aspiration pump 62 is connected to aspiration sidearm 60 by way of
tube 64. Debris collection vessel 66 is connected to aspiration
pump 62 by tube 63. By such arrangement, aspiration pump 62 may be
utilized to withdraw or aspirate debris from the area adjacent the
distal end of the catheter, in a proximal direction, through
aspiration tube member 70 and into debris collection vessel 66.
iv. Preferred Modes of Operation of the Second Embodiment
With reference to FIGS. 8-11, the ultrasound system 10a of the
second embodiment may be operated to effect ultrasonic dilation,
morselling, pulverization or other treatment of obstructive matter
within a vessel or passageway of a mammalian body. Concomitant with
or separate from the ultrasonic treatment, the system 10a may also
be utilized to a) infuse irrigation/coolant/dilation fluid through
the catheter 16a and out of the distal end thereof and b) aspirate
debris, fluid or other matter, in a proximal direction, through the
catheter 16a and into the debris collection vessel 66.
The aspiration and debris collection capability of the system 10a
of the second embodiment is particularly useful in applications
wherein it is desired to promptly remove or suction away any
particles of solid matter which may be created or liberated as a
result of the ultrasonic treatment process. The ability to aspirate
and suction away debris or particles of solid matter is
particularly important in vascular applications, wherein it is
desirable to avoid any embolization or migration of solid matter
into the organ or tissue, which is perfused by the blood vessel
wherein the treatment is being applied. For example, in procedures
wherein ultrasound is utilized to treat or ablate obstructions of
the extracranial and/or intracranial blood vessels which profuse
the brain, it is highly desirable to prevent the passage of any
solid particulate matter into the brain, as such may result in
highly undesirable sequelae such as iatrogenic stroke or
embolization of smaller blood vessels which may be situated
downstream from the site of the treatment procedure. In such
cerebrovascular applications, the ability to promptly aspirate any
solid particles which may have been created or released by the
ultrasonic procedure is useful to prevent such solid particles from
resulting in untoward embolization of the brain.
Arterial blood flow to the brain is provided mainly by four (4)
large extracranial arteries, two common carotid arteries and two
(2) vertebral arteries, which feed smaller intracranial arteries.
The two (2) vertebral arteries originate from the right and left
subclavian arteries, respectively, and pass into the cranium
through the foramen magnum. The vertebral arteries give off
branches to form the anterior spinal artery, the posterior and
inferior cerebellar arteries, and the basilar artery. The common
carotid arteries bifurcate into the internal and external carotid
arteries. The internal carotid arteries pass into the cranium and
give off the ophthalmic, posterior communicating and anterior
choroidal arteries. The internal carotid arteries also form, by
terminal bifurcation, the anterior and middle cerebral
arteries.
Obstructions may form in any of the intracranial or extracranial
cerebral arteries, including all of those described hereabove. Such
obstructions may result from atherosclerotic narrowing of those
arteries, or may come about due to a thromboembolic event, such as
the migration of a blood clot into the cerebral circulation from
the heart or some other location.
The clinical significance and severity of symptoms resulting from
obstruction of the cerebral blood vessels may vary, depending on
the origin or type of obstruction, the location of the obstruction
and other factors. The degrees of resultant ischemia may vary,
ranging from a) a "transient ischemic attack" (TIA) wherein a
transient focal loss of neurologic function occurs, to b) a
"partial non-progressing stroke" (PNS) producing minor persistent
neurologic disability to c) a "completed stroke" (CS) producing
major permanent neurologic disability.
The following are examples of applications wherein the ultrasound
system 10a of the second embodiment of the present invention is
utilized to treat obstructions of the cerebral blood vessels so as
to treat or prevent conditions such as TIA, PNS or CS as described
hereabove.
EXAMPLE 3
In this example, the second embodiment of the ultrasound system 10a
shown in FIGS. 8-11 is utilized to treat an atherosclerotic
obstruction of the extracranial internal carotid artery of a human
being.
Initially, a guidewire 50 is percutaneously inserted into a
peripheral artery and advanced, under radiologic guidance, to a
position whereat the distal end of the guidewire 50 is positioned
in the internal carotid artery immediately upstream of the
obstruction to be treated.
The proximal end of the guidewire is passed into the distal
guidewire aperture 40c of the catheter device 16a and the catheter
device 16a is advanced over the guidewire, with the proximal end of
the guidewire 50 emerging from the sidewall guidewire aperture 41a
as the catheter 16a is further advanced to a point where the distal
head 30c of the catheter 16a is positioned adjacent the obstruction
to be treated.
The guidewire 50 is then fully or partially withdrawn into the
tubular guidewire lumen 51 of the catheter device 16a.
Foot pedal 11a is depressed to energize signal generator 12a such
that an electrical signal emitted by signal generator 12a passes
through line 13a to ultrasound transducer 14a. Ultrasound from
ultrasound transducer 14a passes, via proximal connector assembly
22a, into the proximal end of the ultrasound transmission member
20a and travels through ultrasound transmission member 20a to
distal head member 30c, thereby causing ultrasonic vibration of
distal head member 30c.
Concomitant with the delivery of ultrasound to the distal head
member 30c, a flow of 0.9% Nacl solution is pumped via pump 28a,
through the catheter lumen 26a. Such flow of saline solution
through the catheter lumen 26a accomplishes the dual function of a)
bathing and cooling the ultrasound transmission member 20a to
prevent excessive heat build-up as a result of the ultrasonic
vibration thereof and b) providing a flow of irrigation/dilation
fluid into central fluid passageway 32c, through secondary fluid
passageway 42c and out of fluid outflow apertures 34c.
Also, concomitant with the delivery of ultrasound to the distal
head 30c and the infusion of irrigation/dilation fluid out of fluid
outflow apertures 34c, a suction is applied, via suction pump 62,
through line 64 to aspiration sidearm 60, thereby drawing negative
pressure on the lumen of aspiration tube 70 so as to draw
particulate matter or other debris adjacent the distal tip of the
catheter 16a into the distal aspiration port 72, through aspiration
tube 70 and into debris collection vessel 66.
The flow of saline solution out of the fluid outflow apertures 34c
and the intake of matter into aspiration port 72 may be adjusted
and controlled, by adjustment and control of infusion pump 28a and
aspiration pump 62, such that the two (2) flow rates are
substantially equal to one another, such that saline solution
flowing out of the fluid outflow apertures 34c will circulate
adjacent the distal head member and be subsequently withdrawn into
the aspiration port 72 and through aspiration tube 70 into debris
container 66. By such equilibration of the infusion outflow and
aspiration outflow rate, a continuous fluid turnover may be
affected to accomplish prompt lavage and removal of any particulate
matter or other debris generated adjacent the distal head 30c of
the catheter device 16a.
The catheter 16a may be proximally advanced and/or moved back and
forth so as to effectively treat the obstructive lesion, thereby
improving blood flow and restoring patency to the lumen of the
internal carotid artery wherein the treatment is applied.
When desired, the aspiration pump 62 may be turned off and a
quantity of radiographic contrast medium may be passed into
infusion sidearm 58, through catheter lumen 26a and out of distal
fluid outflow apertures 34c to radiographically visualize the area
of the obstruction for purposes of determining whether the
treatment has effectively ablated or opened the obstruction.
After successful treatment and opening of the obstruction has been
radiographically verified, the catheter device 16a may be withdrawn
and removed.
EXAMPLE 4
In this example, the second embodiment of the ultrasound system 10a
shown in FIGS. 8-11 is utilized to ultrasonically treat an
obstruction of the intracranial middle cerebral artery of a human
being.
Initially, a guidewire 50 is percutaneously inserted into a
peripheral artery and advanced, under radiographic guidance, to a
position whereat the distal end of the guidewire 50 is positioned
within the cerebral artery, immediately upflow of the obstruction
to be treated.
Thereafter, the proximal end of the guidewire 50 is inserted into
the guidewire entry aperture 40c in the distal head 30c of the
catheter device 16a and the catheter device 16a is advanced in the
proximal direction, with the proximal end of the guidewire 50
emerging outwardly through sidewall guidewire aperture 41a. The
advancement of the catheter 16a is continued until the distal head
30c is positioned in the middle cerebral artery immediately
adjacent the obstruction to be treated.
Thereafter, the guidewire 50 is fully or partially withdrawn, at
least to a point whereat the distal tip of the guidewire is within
the lumen 26a of the body of catheter 16a.
Foot pedal 11a is depressed to energize signal generator 12a,
thereby sending an electrical signal through line 13a to ultrasound
transducer 14a. Ultrasound from transducer 14a passes, via proximal
connector assembly 22a, into ultrasound transmission member 20a and
is carried by said ultrasound transmission member 20a to the distal
head 30c of the catheter device 16a, thereby causing the distal
head 30c to vibrate ultrasonically within the desired frequency
range.
Relaxation of the vascular smooth muscle within the middle cerebral
artery results from the ultrasonic vibration within the
above-stated frequency range, thereby causing some dilation of the
middle cerebral artery in the region of the obstruction to be
treated.
Concomitant with the delivery of ultrasound to the distal head
member 30c, a flow of 0.9% NaCl solution is pumped via pump 28a,
through the catheter lumen 26a. Such flow of saline solution
through the catheter lumen 26a accomplishes the dual function of a)
bathing and cooling the ultrasound transmission member 20a to
prevent excessive heat build-up as a result of the ultrasonic
vibration thereof and b) providing a flow of irrigation/dilation
fluid into central fluid passageway 32c, through secondary fluid
passageway 42c and out of fluid outflow apertures 34c.
Also, concomitant with the delivery of ultrasound to the distal
head 30c and the infusion of irrigation/dilation fluid out of fluid
outflow apertures 34c, a suction is applied, via suction pump 62,
through line 64 to aspiration sidearm 60, thereby drawing negative
pressure on the lumen of aspiration tube 70 so as to draw
particulate matter or other debris adjacent the distal tip of the
catheter 16a into the distal aspiration port 72, through aspiration
tube 70 and into debris collection vessel 66.
The flow of saline solution out of the fluid outflow apertures 34c
and the intake of matter into aspiration port 72 may be adjusted
and controlled, by adjustment and control of infusion pump 28a and
aspiration pump 62, such that the two (2) flow rates are
substantially equal to one another, such that saline solution
flowing out of the fluid outflow apertures 34c will circulate
adjacent the distal head member and be subsequently withdrawn into
the aspiration port 72 and through aspiration tube 70 into debris
container 66. By such equilibration of the infusion outflow and
aspiration outflow rate, a continuous fluid turnover may be
affected to accomplish prompt lavage and removal of any particulate
matter or other debris generated adjacent the distal head 30c of
the catheter device 16a.
The catheter 16a may be proximally advanced and/or moved back and
forth so as to effectively treat the obstructive lesion, thereby
improving blood flow and restoring patency to the lumen of the
internal carotid artery wherein the treatment is applied.
When desired, the aspiration pump 62 may be turned off and a
quantity of radiographic contrast medium may be passed into
infusion sidearm 58, through catheter lumen 26a and out of distal
fluid outflow apertures 34c to radiographically visualize the area
of the obstruction for purposes of determining whether the
treatment has effectively ablated or opened the obstruction.
After successful treatment and opening of the obstruction has been
radiographically verified, the catheter device 16a may be withdrawn
and removed.
It will be appreciated that the foregoing drawings, descriptions of
preferred embodiments, and examples serve to describe and
illustrate specific embodiments of the invention but do not
describe or encompass every possible embodiment of the invention
which may be constructed or utilized. Accordingly, it is intended
that the above-set-forth description, drawings and examples be
broadly construed so as to encompass all foreseeable additions,
modifications and alterations which those of skill in the art would
be inclined to make.
* * * * *